Methadone & Other Opiate Maintenance

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Chronicle AM: MJ Taxes Could Generate Billions, Canada to Allow Prescription Heroin, More... (5/16/16)

A Tax Foundation study finds that legal pot could generate $28 billion a year in tax revenues, CBD cannabis oil isn't enough for Oklahoma medical marijuana activists, Canada will allow prescription heroin, and more.

DC activists and veterans head for the White House next week to press for end to marijuana prohibition. (Adam Eidinger/Twitter)
Marijuana Policy

Study Finds Legal Marijuana Could Generate Billions a Year in Tax Revenues. A new report from the Tax Foundation estimates that a nationwide "mature marijuana industry" could generate up to $28 billion a year in federal, state, and local tax revenues. That would include $7 billion for the feds, $5.5 billion in business taxes, and $1.5 billion from income and payroll taxes. The report also estimated that a 10% federal surtax could generate $5.3 billion a year.

Veterans, DC Activists to Rally at White House on May 20. Organizers with the Weed For Warriors Project and the DC Cannabis Campaign are planning to rally in front of the White House to call on the Obama administration to end federal marijuana prohibition. The date, May 20, marks the 124th anniversary of the birth of arch-prohibitionist and proto-drug warrior Harry Anslinger, head of the Federal Bureau of Narcotics for three decades in the mid-20th Century.

Medical Marijuana

Montana Medical Marijuana Supporters Appeal to US Supreme Court. The Montana Cannabis Industry Association last Thursday filed a petition with the US Supreme Court seeking to reverse a state Supreme Court decision that guts the state's once-thriving medical marijuana industry. Petitioners argue that the state Supreme Court mistakenly held that marijuana is universally illegal under federal law and point to the Obama administration's decisions to allow states to implement their own marijuana laws.

Oklahoma Governor Signs CBD Cannabis Oil Bill. Gov. Mary Fallin (R) has signed into law a CBD cannabis oil expansion bill. Last year, the state approved the use of the oil, but only for people under 18. This bill removes that age restriction.

Oklahoma Medical Marijuana Advocates Begin Initiative Signature Gathering Campaign. CBD cannabis oil isn't enough for Oklahomans for Health, which began gathering signatures over the weekend for a full-blown medical marijuana initiative. The group has 90 days to gather 66,000 valid voter signatures to get the measure on the November ballot.

Heroin and Prescription Opioids

Congress Passes Comprehensive Addiction and Recovery Act. Both houses of Congress have approved the measure, Senate Bill 524 and HR 953, which now goes to President Obama. The bill would expand the availability of naloxone, increase prescription drug monitoring programs, increase jail- and prison-based drug treatment, and bar the Education Department from asking about drug convictions on federal student loan application forms, among other provisions. The bill does not include extra funding to pay for its measures.

Obama Administration Calls on Congress to Fund $1.1 Billion for Opioid Effort. Last Thursday, as Congress was passing the Comprehensive Addiction and Recovery Act, the Obama administration noted that Congress didn't allocate money to pay for it and called on Congress to come up with $1.1 billion in additional spending to do so.

International

Canada to Allow Prescription Heroin. Health Canada announced Friday that it is proposing new regulations to allow access to prescription heroin under its Special Access Program (SAP). That program allows for emergency access to drugs for serious or life-threatening conditions when conventional treatments have failed or are unsuitable. "A significant body of scientific evidence supports the medical use of diacetylmorphine, also known as pharmaceutical-grade heroin, for the treatment of chronic, relapsing opioid dependence. Diacetylmorphine is permitted in a number of other jurisdictions, such as Germany, the Netherlands, Denmark, and Switzerland, to support a small percentage of patients who have not responded to other treatment options, such as methadone and buprenorphine," the statement said.

Macedonia Will Have Medical Marijuana by Month's End. Health Minister Nikola Todorov said Saturday that medical marijuana products will be in pharmacies across the country by the end of the month. The country had earlier amended its Law on the Control of Drugs and Psychotropic Substances to allow the move.

In Cutting Edge Move, Canada to Allow Prescription Heroin

This article was produced in collaboration with AlterNet and first appeared here.

Health Canada announced Friday that it is proposing new regulations to allow access to prescription heroin under its Special Access Program (SAP). That program allows for emergency access to drugs for serious or life-threatening conditions when conventional treatments have failed or are unsuitable.

Health Canada clears the way for prescription heroin. (Wikmedia/Creative Commons)
"A significant body of scientific evidence supports the medical use of diacetylmorphine, also known as pharmaceutical-grade heroin, for the treatment of chronic, relapsing opioid dependence. Diacetylmorphine is permitted in a number of other jurisdictions, such as Germany, the Netherlands, Denmark, and Switzerland, to support a small percentage of patients who have not responded to other treatment options, such as methadone and buprenorphine," the statement said.

The move is yet another reversal of hardline Conservative drug policies by the Liberal government headed by Prime Minister Justin Trudeau, which was elected last fall. The Trudeau government has pivoted sharply away from Conservative positions in favor of mandatory minimum drug sentences and against marijuana legalization, and now is moving to undo Conservative efforts to block the limited use of prescription heroin.

Canadian scientists had laid the groundwork for prescription with the North American Opiate Medication Initiative (NAOMI), which first tested "heroin-assisted maintenance" in Vancouver a dozen years ago, and which was followed by the Study to Assess Long-Term Opioid Maintenance Effectiveness (SALOME) between 2005 and 2008. SALOME examined whether giving hard-core heroin users heroin was more effective than giving them methadone.

SALOME showed that the users in the study were more likely to stay in treatment, reduce other illegal drug use, engage in fewer other illegal activities and have better physical and mental health outcomes if given heroin than if given methadone. But when that study ended in 2008, researchers were faced with the ethical dilemma of cutting off the patients whose lives were being improved by prescription heroin.

The doctors began applying for, and receiving, permission under the Special Access Program, and Health Canada approved those applications in 2013. But that infuriated the Conservatives, and then-Health Minister Rona Ambrose introduced new regulations to bar doctors from prescribing "dangerous drugs" such as heroin, cocaine, and LSD.

Former SALOME participants launched a constitutional challenge to the ban and in 2014 won a temporary injunction giving them the right to continue to receive prescription heroin while the case was being decided. Now, with Health Canada's move, the federal government will no longer attempt to block prescription heroin.

That was good news for the Pivot Legal Society, which argued the case for continuing the prescriptions, and for Providence Health Care, in whose Crosstown Clinic in Vancouver's Downtown Lower East Side the heroin was administered.

"Allowing access to diacetylmorphine, or medical heroin, to patients who need it, ensures that life-saving treatments get delivered to vulnerable people suffering from chronic opioid use," the two groups said in a joint statement.

Canada is leading the way on cutting edge responses to heroin addiction in North America. In addition to the groundbreaking NAOMI and SALOME studies, which cannot be replicated in the US under current law and regulations, Canada has also had safe injection sites operating in Vancouver for more than a decade. We still don't have any of those in the US.

Ottawa
Canada

Chronicle AM: New Obama Opioid Initiative, DOJ Backtracks on Forfeiture Reform, More... (3/29/16)

The drug czar uses a recycled and updated version of the gateway theory to oppose marijuana legalization, the Justice Department restarts its Equitable Sharing asset forfeiture program, the president announces a new package of initiatives to fight heroin and opioid death and addiction, and more.

Obama has plans for fighting heroin and prescription opioid death and addiction. (wikimedia.org)
Marijuana Policy

Drug Czar Leans On Gateway Theory Variant to Explain Opposition to Legalization. In a hearing before the House Committee on Oversight and Government Reform last week, Office of National Drug Control Policy head Michael Botticelli reaffirmed the Obama administration's opposition to marijuana legalization, using a familiar, if discredited, argument to do so: "I think the evidence is pretty clear that early use of alcohol, tobacco and marijuana -- often used together -- significantly increases the probability that someone will develop a more significant addictive disorder later in their life," he said. "Early substance use actually effects brain development and predisposes people for more significant vulnerabilities later in their life." That sounds a whole lot like an updated version of the roundly criticized gateway theory.

Hawaii Resolution Seeks Study on Marijuana and Driving. Rep. Cindy Evans (D-North Kona) and 15 other lawmakers have introduced a resolution asking the state health department to study the effect of marijuana on driving. State law bans people from driving under the influence of impairing drugs, but there is no threshold set for marijuana because there is no widespread consensus on what an acceptable level might be.

Heroin and Prescription Opioids

Obama Announces New Moves to Fight Heroin and Opioid Abuse. In a speech in Atlanta today, President Obama unveiled a package of new initiatives to help stem the tide of death and addiction from prescription and non-prescription opioids. These initiatives are above and beyond the $1.1 billion in new spending he proposed last month. The package includes expanded access to medication-assisted treatment (methadone, buprenorphine) for addicted users, doubling the cap on the number of patients to whom a doctor may prescribe buprenorphine, increasing the number of doctors who can prescribe it, funding an increase in access to the overdose reversal drug naloxone (Narcan), ensuring that substance abuse and mental health benefits are offered for Medicaid and the Children's Health Insurance Program, and $7 million for the Justice Department to conduct law enforcement operations aimed at heroin distribution.

Asset Forfeiture

Justice Department Resumes Equitable Sharing Program -- More Money for Cops. The Justice Department has announced it is resuming its program that allows state and local law enforcement agencies to do an end run around state asset forfeiture laws by handing investigations over to the feds. State laws may mandate that seized funds go in the general fund or other specified funds, but under the federal program, 80% of the seized funds go to the seizing law enforcement agency, not the state's general or other specified funds. Law enforcement lobbying groups had been loudly protesting the program's shutdown last fall, claiming they needed the windfalls to do their jobs. Now, the program is back on line.

Harm Reduction

Overdose Reversal Drug Naloxone Has Saved 2,500 Lives in North Carolina. In less than three years, some 2,500 North Carolinians have had their heroin or prescription opioid overdoses reversed by people using naloxone (Narcan), the North Carolina Harm Reduction Center reported today. As of today, the number stands at 2,503. "Through distributing naloxone with NCHRC, I have been able to save the lives of many of my friends, loved ones and peers," says Kendra, a volunteer distributor in Wilmington. "Without this amazing group of people and this life-saving drug, many people who are very close to me may not have had a second chance at life. In the last few months alone I have had close to 100 reversals reported to me personally and many of those people are now in recovery because they were ready to make a change in their lives after overdosing."

International

Mexican Popular Support for Marijuana Legalization Rising, But Still Low. This year's officially-supported debate on marijuana legalization appears to be having an impact. Mexico has never been a legalization-friendly country, and in October, daily polls had support for legalization at only 7%, with 92% opposed. But six months later, after the issue has been publicly debated, pro-legalization sentiment has increased four-fold, to 29%, with opposition dropping to 66%. The trend is in the right direction, but there's still a long way to go.

Chronicle AM: VT Gov Urges Lawmakers to Pass Legal Pot Bill, House Dems Urge Obama to Stand Tall at UNGASS, More... (3/18/16)

The taxman is happy in Oregon, Vermont's governor would be happy if the House passed the pot bill, New Orleans is a signature away from decriminalizing pot, Wisconsin's governor signs a package of bills to tamp down heroin and pain pill use, and more.

Some House Democrats are calling on President Obama to use the UNGASS on Drugs as a bully pulpit for global drug reform.
Marijuana Policy

Oregon Took in $3.48 Million in Marijuana Taxes in January. Even though legal marijuana is still for sale only through medical marijuana dispensaries, the state still sold an estimated $14 million worth of non-medical weed, resulting in the $3 million-plus funding gift to the state. State officials had predicted the take would be about $1 million.

Vermont Governor Urges House to Pass Legalization Bill. Gov. Peter Shumlin (D) told legislators "the time is now to take a smarter approach to marijuana" in a statement released Friday. "The stakes are important. The bill passed by the Vermont Senate would represent the most careful, deliberate attempt to regulate marijuana in America. Before passing the bill, the Senate took testimony from experts, asked the right questions, and learned lessons from those states that have legalized marijuana already. The result is a bill to create a system which would represent a huge improvement over the status quo….The choice in front of Vermonters and their elected representatives in the next couple of months is whether we want our state to take a rational step to end an antiquated War on Drugs policy that almost everyone agrees has failed. We can take a smarter approach in Vermont and be prepared for whatever other states around us do. But we must have the courage to do it." The House has taken up the legalization bill, Senate Bill 241, this week.  

New Orleans City Council Approves Decriminalization. The council voted unanimously Thursday night to approve an ordinance allowing police to write tickets instead of arresting people caught in possession of small amounts of marijuana. Fines will start at $40 and be capped at $100. The ordinance still needs to be signed by Mayor Mitch Landrieu.

Heroin and Prescription Opioids

Wisconsin Governor Signs Bill Package Targeting Heroin, Pain Pills. The package signed by Gov. Scott Walker (R) includes Assembly Bill 364, which requires doctors to check a database whenever they fill or refill a prescription for abusable drugs; Assembly Bill 365, which requires police to provide information to the Prescription Drug Monitoring database when they find evidence of prescription drugs being abused or stolen; Assembly Bill 366, which requires pain clinics to be certified by the state; Assembly Bill 367, which requires methadone clinics to provide relapse and other information to the state;  Assembly Bill 658, which makes it a crime to possess a use a masking agent to foil a drug test; and Assembly Bill 659, which streamlines rules for opioid treatment programs.

Drug Policy

House Democrats Urge Obama to Go Big at the UNGASS on Drugs. Fourteen House Democrats have urged President Obama to use the UNGASS as a bully pulpit for a call for substantive global drug reforms and moving away from failed criminalization strategies. Led by Reps. Earl Blumenauer (OR) and John Conyers (MI), the group urged the president to "take full advantage of this timely and powerful event to communicate our progress toward a more effective, science-based approach to drugs to the rest of the world." The Democrats called for Obama himself to deliver the US position before the General Assembly. "That unique platform gives you the opportunity to elevate the 2016 UNGASS on the World Drug Problem and change the way drug policy is approached, not only domestically, but also around the world, establishing the United States’ commitment to a new approach on an international scale," the letter reads.

International

Canada Petition Calling for Full Marijuana Legalization Gaining Steam. A petition asking the Canadian government to fully repeal marijuana prohibition is picking up signatures, especially in British Columbia. There are more than 12,000 signatures so far, more than 5,000 of them from BC. The petition launched by federal Green Party leader Elizabeth May calls for removing marijuana from the Controlled Drugs and Substances Act, ending police actions against existing storefronts, granting of pardons and expungements of criminal records to pot criminals, and leaving the regulation and taxation of marijuana commerce to the states. The Liberal government has said it is going to legalize it, but it hasn't said how or when. 

Chronicle AM: UK Lib Dems Call for Marijuana Legalization, MD Harm Reduction Bills Get Hearing, More... (3/8/16)

Massachusetts lawmakers have problems with pot legalization, a Utah medical marijuana bill gets gutted, a Florida medical marijuana bill goes to the governor, groundbreaking harm reduction bills get a hearing in Maryland, Britain's Liberal Democrats call for pot legalization, and more.

Britain's third political party calls for marijuana legalization.
Marijuana Policy

Poll: Illinois Not Quite There Yet on Marijuana Legalization. A new Paul Simon Public Policy Institute poll has support for legalization at 45%, with 51% opposed. Medical marijuana does much better, with 82% in favor.

Massachusetts Senate Committee Issues Report on Dangers of Marijuana Legalization. A day after legalization got a raucous hearing at the state house, the Special Senate Committee on Marijuana issued a report saying it had "serious concerns about the prospect of legalizing marijuana for recreational use and sale" in the state. Legalization could make it easier for children to get access to the plant and more difficult for law enforcement trying to enforce impaired driving laws. The report calls for setting a legal driving limit for THC levels in the blood, requiring health risk warnings on marijuana products, and barring home cultivation, among other recommendations.

Medical Marijuana

Florida Senate Passes Medical Marijuana Expansion Bill. The Senate Monday approved House Bill 307, which would allow terminally ill patients to use medical marijuana. The bill now goes to the desk of Gov. Rick Scott (R).

Utah House Committee Kills Broad Medical Marijuana Bill, Tries to Merge It With Another One. The House Health and Human Services Committee effectively killed Senate Bill 73, backed by medical marijuana supporters, then tried to blend in some of its provisions into Senate Bill 89, which would allow doctors to recommend medical marijuana products, but would also impose stricter regulations on its use. Sen. Mark Madsen (R-Saratoga Springs), sponsor of SB 73, said the compromise wasn't good enough. "It's like trying to put live organs in a cadaver and expect some kind of good outcome. It is fundamentally, functionally constructed to fail," Madsen said. "It's entirely possible they wanted it to fail all along. I don't think it's going to come close to meeting any of the needs for the people. It was a placebo bill from the beginning and was intended to torpedo my bill." Medical marijuana activists will now most likely move forward with a threatened initiative.

Virginia Lawmakers Approve CBD Cannabis Oil Bill. The House Monday passed Senate Bill 701, which would allow the cultivation and use of two cannabinoids—CBD and THC-A—for patients suffering from severe epilepsy. The measure has already passed the Senate and now heads the desk of Gov. Terry McAuliffe (D).

Harm Reduction

Maryland Hearing Today on Groundbreaking Harm Reduction Bill Package. The House of Delegates is today holding hearings on two bills from Del. Dan Morhaim (D-Baltimore County) that are part of paradigm-shifting, four-bill harm reduction package. House Bill 1212 would allow for supervised consumption rooms, while House Bill 1267 would take initial steps toward enacting a pilot project in heroin and other opioid maintenance therapy.

International

British Liberal Democrats Call for Marijuana Legalization. In a report issued today, A Framework for a Regulated Cannabis Market in the UK, Britain's third largest political party called for legalizing marijuana and said it would be a billion dollar a year industry in the United Kingdom.  

Chronicle AM: VT Senate Gives First Approval of Legalization Bill, CT MedMJ Expansion, More... (2/24/16)

Marijuana legalization advances in Vermont; medical marijuana advances in Connecticut, Australia, and Canada; Eric Holder says it's time to reschedule marijuana, Obama says restricting pain pills won't solve the opioid crisis, and more.

Busy, busy in New England. (wikimedia.org)
Marijuana Policy

Arkansas Attorney General Rejects Another Marijuana Legalization Initiative. Attorney General Leslie Rutledge (R) has again rejected a proposed constitutional amendment to legalize marijuana, citing ambiguities in the text. The Arkansas Cannabis Amendment, filed by Mary Berry, was rejected the first time earlier this month.

Vermont Senate Approves Legalization in Preliminary Vote. The Senate voted 16-13 to approve Senate Bill 241, which would regulate, tax, and legalize marijuana. The bill, which is supported by Gov. Peter Shumlin (D), faces one more Senate vote before heading to the House. That vote is expected to come tomorrow.

Minneapolis City Council Takes Up Decriminalization. The council will decide this week whether small-time marijuana possession should be a misdemeanor or a petty misdemeanor under city ordinance. The current ordinance makes it a misdemeanor punishable by a fine, jail time, and a criminal record. That's tougher than state law, which makes it a petty misdemeanor, which is punishable only by a fine and carries to criminal record.

Medical Marijuana

Former Attorney General Eric Holder Now Supports Rescheduling Marijuana. In an interview with PBS, Holder signaled newfound support for rescheduling and decriminalizing marijuana. It's not something he acted on while in office, but he now says: "I certainly think it ought to be rescheduled. You know, we treat marijuana in the same way we treat heroin now, and that clearly is not appropriate."

Connecticut Legislators Expand Qualifying Conditions for Medical Marijuana. The legislature's regulation review committee Tuesday approved expanding the state's program by adding six new qualifying conditions: ALS, or Lou Gehrig's disease; ulcerative colitis; sickle cell disease; severe psoriasis and psoriatic arthritis; complex regional pain syndrome; and post-laminectomy syndrome with chronic radiculopathy, which is recurring back pain after surgery. No other approval is required since these were regulatory, not legislative, changes. The changes will go into effect in 30 days.

Heroin and Opiates

Obama Says Restricting Opiate Prescriptions Won't Solve Crisis. At the National Governors' Conference last weekend, the governors recommended limiting the number of opioid pain relievers doctors can prescribe, but President Obama wasn't buying that. "If we go to doctors right now and say 'Don't overprescribe' without providing some mechanisms for people in these communities to deal with the pain that they have or the issues that they have, then we're not going to solve the problem, because the pain is real, the mental illness is real," Obama said in a meeting with governors Monday. "In some cases, addiction is already there."

Harm Reduction

Ithaca, New York, Unveils Comprehensive Drug Policy Plan. At a press conference today, Ithaca officials unveiled a comprehensive plan to deal with drug use from a public health perspective with a strong harm reduction component. The Ithaca Plan: A Public Health Approach to Drugs and Drug Policy, calls for the creation of a Vancouver-style Four Pillars (prevention, treatment, harm reduction, law enforcement) approach to the city's problems, particularly with heroin and opioid drug use. The plan recommends allowing supervised injection facilities and heroin maintenance, among other proposals.

International

Canadian Federal Judge Throws Out Ban on Patient Medical Marijuana Grows. A Vancouver-based federal judge ruled Wednesday that Health Canada regulations restricting patient medical marijuana grows violating charter rights and thus have no force and effect. But Judge Michael Phelan also gave the government six months to come up with new rules. In the meantime, an injunction allowing thousands of patients to grow their own remains in effect.

Australian Parliament Approves Medical Marijuana. Medical marijuana cleared the upper house Wednesday, clearing the way for its use Down Under. But several steps remain to be taken before a program gets up and running.

A Maryland Lawmaker's Paradigm-Shifting Approach to the Heroin and Pain Pill Crisis [FEATURE]

With nearly 47,000 Americans dying of drug overdoses in 2014 -- more than from gunshots or car crashes -- the problem of heroin and prescription opioid (pain pill) addiction is getting well-deserved attention. From community town halls to state capitals, as well as in Congress and on the rival presidential campaigns, the crisis is spawning demands for solutions.

http://stopthedrugwar.org/files/dan-morhaim-180px.jpg
Dan Morhaim
The response, in general, has been more sympathetic than to earlier waves of hard drug use, such as heroin in the 1960s or crack cocaine in the 1980s, which brought down the harsh drug war policies of Nixon and Reagan. Now, there are more calls for drug treatment than for further law enforcement crackdowns, police departments are carrying overdose reversal drugs, and public health agencies are taking on a more prominent role.

But addicts continue to be arrested, with all the deleterious consequences that entails, and, when it comes to policy, the problem of addiction remains largely in the realm of criminal justice. Harm reduction practices proven in other parts of the world improve both the lives of drug users and those of the communities they live in continue to be shunted aside in the US.

That could change in at least one state. Veteran Maryland Delegate Dan Morhaim (D-Baltimore County) has just introduced a paradigm-shifting package of bills that would begin to move the state's posture toward drug use from prohibition to public health and harm reduction. Morhaim, a practicing physician with three decades of frontline hospital ERs, brings to his approach a vision formed by that experience.

If enacted, Morhaim's package would mark a radical, but commonsensical, humane, and scientifically-supported shift in Maryland's drug policies. Here's what it includes:

  • Emergency Room Treatment on Demand. House Bill 908 provides treatment on demand in emergency rooms and hospital settings. The bill requires acute care hospitals to have a counselor available or on-call at all times and specified arrangements for transferring patients to appropriate treatment settings. Addicted patients make up a large percentage of uninsured visits to ERs, making them an ideal place for initial therapeutic contact.
  • Safe Consumption Sites. House Bill 1212 allows individuals to use drugs in approved facilities while supervised by trained staff who also provide sterile equipment, monitor the person for overdose and offer treatment referrals. Similar on-going programs in Australia, Canada, and several European countries have eliminated overdose deaths, reduced the spread of disease, and provided points of accessto the most hard-to-reach drug users.
  • Drug Decriminalization. House Bill 1219 decriminalizes the possession and use of small quantities of drugs: one gram of meth or heroin, two grams of cocaine, 10 hits of MDMA, 150 micrograms of LSD. The object is to keep otherwise non-criminal drug users out of the criminal justice system, saving resources and avoiding saddling more residents with criminal records.
  • Heroin Maintenance. House Bill 1267 allows a four-year pilot study of "poly-morphone assisted treatment" with pharmaceutical grade opioids, including heroin, to treat under medical supervision a small number of hardcore users who have proven resistant to other forms of treatment. Ongoing heroin maintenance programs in several European countries have been shown to reduce illegal drug use, decrease crime, reduce the black market for heroin, and lead to less chaotic lives for their participants.

The package didn't exactly come out of nowhere. Morhaim's experiences in the ER, where he dealt not only with direct consequences of drug use -- overdoses, infections -- but also direct consequences of drug prohibition -- old women injured in muggings for black market drug money, the toll of dead and wounded in black market drug turf battles -- colored his approach.

"I'm a physician, not a prosecuting attorney," Morhaim told the Chronicle. "I come at this from a public health perspective. We talk about 'surges' to fight this and that, but what we haven't had in this country is a surge in the public health approach, real, substantive public health. This is different, and some will see it as controversial, but I'm comfortable with that. This is something that's really corroding the heart and soul of our society."

He wasn't alone.

"I've had a lot of conversations, and my district has generally been very supportive of these kind of innovative things. No negative feedback. There's a broad consensus that the war on drugs is a failure," Morhaim said. "People are really cognizant of that. And I'm an Emergency Room physician at a Level II trauma center, I've also done healthcare for the homeless. I've been on the front lines, seen the carnage, the death, the violence, and the way this affects the families, and I'm speaking from true experience, and people respect that."

Not only did Morhaim have support in his community, he had support from a strong group of advocates and experts.

"As things were coming to a head, Delegate Morhaim reached out to us at the Drug Policy Alliance (DPA)," said DPA staff attorney Lindsay LaSalle, who was involved in developing the proposals. "He said he felt like he could offer progressive solutions to the crisis and he wanted our subject matter expertise to help develop those proposals."

DPA, Law Enforcement Against Prohibition (LEAP), whose executive director, Neill Franklin, is a former Baltimore police officer, and the Open Society Foundations joined with academics, lawyers, doctors, and harm reductionists to develop and refine the policy proposals that became the bill package. Local institutions of higher learning, including the University of Maryland, the University of Baltimore, and Johns Hopkins University, had academics involved in the effort as well.

Passing the bills won't be easy, and it's not likely to happen this year, but Morhaim and his supporters are playing to win in the not-too-distant future.

"Dan is currently on the second year of a four year term," LaSalle said. "These bills were introduced strategically this term with the understanding that it would be a year of educating colleagues and generating positive media coverage. This is always a long game; we don't expect passage this year, but we hope to gain traction on one or more of these in the next two or three years."

"I've been in the legislature a long time, and I've learned you just have to be persistent, you listen and address concerns, maybe you accept an amendment to a bill," Morhaim said.

He pointed to the successful effort to get medical marijuana through the legislature.

"On that, people had suggestions, and we said let's fix it in the bill," he recalled. "Law enforcement didn't oppose it because I sat down and worked with them."

He also recalled legislative battles he had fought -- and won -- around smoking in restaurants and the use of safety seats for children.

"Banning smoking in restaurants seemed impossible in 1995, but now it's commonplace," he said. "The same with kids safety seats. Both of those were hard-fought on the political level, but when we talk to people, we can convince them. These things take time, but when you recognize what's not working, then you can explore what is. People are looking for answers."

Although Morhaim's package of bills is the most comprehensive, explicit harm reduction interventions are being considered in other places, too. California will see a safe consumption site bill introduced next week, and activists and officials in a number of cities, including New York City, San Francisco, and Seattle are laying the groundwork for such facilities at the local level.

"We're getting traction on these issues," said LaSalle. "Nevada was the first state with a heroin-assisted treatment bill, and while it didn't get out of committee, we had robust hearings, with international experts. And that California bill will be moving forward this session. Drug treatment and harm reduction don't always go hand in hand, but in this case the treatment community is cosponsoring or officially supporting safe consumption sites."

Meanwhile, some states are moving in the opposite direction. In Maine, the administration of Tea Party Gov. Paul Le Page (R) is seeking to reverse a law passed last year that defelonized drug possession. (The rambunctious Republican has also called for guillotining drug dealers, blamed black drug dealers for impregnating white Maine girls, and called for vigilantes to shoot drug dealers.) And next door in New Hampshire, the attorney general wants to start charging heroin suppliers with murder in the event of fatal overdoses. Prosecutors in other states have also dusted off long-unused statutes to bring murder or manslaughter charges.

"We need to ask those people why they're doubling down on a failed policy," said LaSalle. "Why would this work now when it's just more of the same that's been in place for four decades, and now we have use and overdoses and Hep C increasing."

"I understand the impulse to 'Do Something!' in response, and because criminalization has been our go-to response, it seems logical that increasing penalties or prosecutions is a way to solve the problem, but we know, we have shown, that it is not. It's frustrating."

It can be worse than frustrating, too, LaSalle noted.

"Using murder charges as a whipping stick in the case of overdoses is really counterproductive," she said. "If the goal is to reduce overdoses, this is going to reduce the likelihood of anyone calling 911. Maybe they shared their stash, and if they could face murder charges, they now have a serious disincentive to call."

Clearly, the war on drugs is not over. But after half a century of relying predominantly on the forces of repression to deal with drug use, a new vision, both smarter and more humane, is emerging. Now comes the political fight to enact it.

Annapolis, MD
United States

Could Kratom Be a Better Choice for Heroin and Pain Pill Users? [FEATURE]

This article was produced in collaboration with AlterNet and first appeared here.

The Southeast Asian herb is now available powdered...
A Southeast Asian herb is gaining popularity among addicted heroin and prescription opiate users, pain sufferers, and hipsters looking for a nice buzz, and it's legal -- at least for now. It's usually consumed as a tea, and is now available at non-alcohol kratom bars in several states, as well as in powdered from in specialty shops and on the Internet.

It is regulated as an herbal supplement, not a controlled substance, but it is coming under some scrutiny by lawmakers and regulators. The FDA banned its import in 2014, and the DEA has it listed as a drug of concern, but has not moved to criminalize it. It is illegal in four states, though -- Indiana, Tennessee, Vermont and Wyoming -- and similar laws are now being proposed in Florida and New Jersey.

The stuff is called kratom, and was traditionally used in Thailand and Malaysia to help endure physical labor, relieve pain, and stop diarrhea. It was also good for relieving the symptoms of opium withdrawal.

That's because its active ingredients activate the same opioid receptors heroin and prescription pain pills do. And it behaves like an opiate -- with a couple of exceptions, one interesting and one quite important.

...or it can be brewed into a tea. (wikimedia.org)
Like other opiates, it relieves pain, slows bowel activity, produces euphoric feelings, and creates physical addiction and a whithdrawal syndrome. But unlike other opiates, it causes a pleasant, caffeine-type buzz in small doses. More significantly, it is apparently very difficult -- if not impossible -- to overdose on. The few deaths where kratom is implicated include poly-drug use, or as in a case reported by the New York Times, suicide by a young kratom user who was also being treated for depression.

"Direct kratom overdoses from the life-threatening respiratory depression that usually occurs with opioid overdoses have not been reported," says Oliver Grundmann, clinical associate professor of medicinal chemistry at the University of Florida, told journalist Maia Szalavitz at Vice. Grundmann should know; he just reviewed the research on kratom for the International Journal of Legal Medicine.

"It's a fascinating drug, but we need to know a lot more about it, Dr. Edward W. Boyer, a professor of emergency medicine at the University of Massachusetts Medical School and a co-author of several scientific articles on kratom, told the Times. "Recreationally or to self-treat opioid dependence, beware -- potentially you're at just as much risk" as with an opiate.

Well, except for that whole fatal overdose thing. And like the kratom high, the physical dependence appears much milder.

Szalavitz consulted Mark Swogger, an assistant professor of psychiatry at the University of Rochester Medical Center, who with his colleagues analyzed 161 "experience reports" posted by kratom users on the drug information site Erowid.org for a recent study in the Journal of Psychoactive Drugs.

"I think it's pretty safe to say that kratom has at least some addiction potential. The data is fairly strong on that and our study also found that people are reporting addiction," but "overall, we found that it's really mild compared to opioid addiction and it didn't seem to last as long."

About one in six of the users reported nausea or stomach pain and 6% actually vomited. There have been a handful of other handful of reports of liver problems.

All this makes kratom something like opium's mild-mannered little sister. And that is apparently something a lot of people are looking for.

One of them was Susan Ash, 46, who told the Times she began taking kratom while being treated for dependence on prescription pain relievers and now takes a small dose daily to ease chronic pain and depression.

She was so impressed with the results that last year, she founded the American Kratom Association to represent consumers. The group now has more than 2,000 members and lobbies against bills to ban the herb.

"We know from all our experiences that kratom has the potential to be a wonderful medicine," she said. "We're all experiencing that it's changing our lives. We do agree that more science is needed to actually prove this potential that we know it has."

Yes, more science is needed, and kratom does have its disaffected users, as the Times was quick to dig up, but so far, it looks like we have a drug like opium, but with attenuated effects. If people are taking kratom to get off heroin or prescription pills or to treat pain or just to get a nice buzz, and they're not overdosing by the tens of thousands, as they are with the opiates, that would seem like an overall good thing. If we want to reduce harm from heroin and prescription opiates, kratom should be studied and, perhaps, embraced, not proscribed.

Chronicle AM: Fed Bill Would Allow MJ Ad Mailings, Far-Reaching MD Bills Filed, More... (2/5/16)

Oregon's federal representatives fight to protect marijuana advertising, medical marijuana and CBD bills are moving in the states, a Maryland delegates files bills for drug treatment on demand, supervised injection sites, opiate maintenance (including heroin), and drug decriminalization -- quite a package! -- and more.

A Maryland bill could lead to the first supervised injection facility in the US. (vch.ca)
Marijuana Policy

Oregon Federal Reps File Bill to Allow Published Marijuana Ads. Responding to warnings from the US Postal Service that mailing newspapers or magazines with marijuana advertising is prohibited even in states where it is legal, Oregon's two Democratic senators, Ron Wyden and Jeff Merkley, have joined with two Democratic House members, Earl Blumenauer and Suzanne Bonamici, to file the Marijuana Advertising in Legal States (MAILS) Act (HR 4467). The bill would reverse the USPS policy. "Federal agencies must respect the decisions made by law-abiding Oregonians and small business owners in the state," Wyden said. "Our bill updates the federal approach to marijuana, ending the threat to news publications that choose to accept advertising from legal marijuana businesses in Oregon and other states where voters also have freely decided to legalize marijuana."

Michigan Legalization Campaign Getting Close to Signature Goal. The MILegalize campaign says it has already collected some 240,000 raw signatures and is seeking another 100,000 to ensure a comfortable cushion for invalidated signatures. The state requires 252,000 valid voter signatures to qualify for the November ballot.

Medical Marijuana

Alabama Bill Would Expand Access to CBD Cannabis Oil. Rep. Mike Ball (R-Madison County) has introduced House Bill 61, which would expand access to CBD beyond a limited study program at the University of Alabama-Birmingham. The new bill would allow parents with a valid recommendation for CBD cannabis oil to possess it in the state.

Delaware Bill Would Allow CBD Cannabis Oil for Kids in Schools. Sen. Ernie Lopez (R-Lewes) has filed Senate Bill 181, which would allow authorized caregivers to possess and administer CBD cannabis oil to pupils in school as needed.

Utah Medical Marijuana, CBD Cannabis Oil Bills Move. Two medical marijuana-related bills are headed for the Senate floor after winning committee votes. Senate Bill 73, filed by Rep. Mark Madsen (R-Saratoga Springs), would allow whole plant medical marijuana, while Senate Bill 89, sponsored by Sen. Evan Vickers (R-Cedar City), would expand on CBD cannabis legislation passed last year.

Kratom

Florida Bill to Ban Kratom Advances. A bill that would ban the increasing popular Southeast Asian herb, which some are using as an alternative to opiates or as a means to withdraw from them, has passed the House Criminal Justice Subcommittee. The bill, House Bill 73, would make possession of kratom a misdemeanor. A similar measure seeking to make possession a felony failed last year.

New Synthetic Drugs

Kentucky Bill to Toughen Penalties for New Synthetic Drugs Advances. A bill that would increase penalties for possessing or selling new synthetic drugs has passed the House Judiciary Committee. The bill is House Bill 66.

Drug Policy

Maryland Bill Package Attempts Comprehensive Drug Decriminalization, Harm Reduction Approach. A set of four bills being filed today would upend the way the state deals with drug use and related problems. One bill would provide for drug treatment on demand in emergency rooms and hospital settings, a second bill would allow for safe injection facilities (there are currently none in the US), a third bill would allow for opiate maintenance therapy, including with heroin, and a fourth bill would decriminalize the use and possession of personal use quantities of illicit drugs. The package is being sponsored by Delegate Dan Morhaim (D-Baltimore County).

Drug Testing

Utah Bill Would Repeal Welfare Drug Testing Law. Since Utah approved a welfare drug testing law, only 47 applicants out of nearly 14,000 have tested positive for drugs. That's enough for Rep. Angela Romero (D-Salt Lake City) to call for an end to the program. Her House Bill 172 would do just that. It is currently before the House Economic Development and Workforce Services Committee.

Chronicle AM: Obama Wants $1 Billion to Fight Opioids, Legal Pot Sales Hit $5.4 Billion, More... (2/2/16)

A new report finds marijuana is a booming market, California doctors get on board with the AUMA legalization initiative, the White House wants nearly a billion bucks to fight opioid addiction -- with most of it going for "medication-assisted treatment" -- and more.

People line up to buy heroin in Chicago. The White House wants nearly $1 billion to fight opioid addiction. (Chicago PD)
Marijuana Policy

Legal Pot Sales Hit $5.4 Billion Last Year, Report Says. Legal marijuana sales increased 17.4% last year to $5.4 billion, according to data released this week by the ArcView Group. Nearly 80% of the sales were for medical marijuana, but $998 million was for legal adult use, up dramatically from $351 billion in 2014. Overall sales should grow to $6.7 billion this year, the group predicted.

California Medical Association Endorses AUMA Legalization Initiative. The CMA, the largest doctors' group in the state, announced Monday that is will support the Adult Use of Marijuana Act legalization initiative. The initiative, funded by tech billionaire Sean Parker and supported by Lt. Gov. Gavin Newsom (D), has as one of its proponents Dr. Donald Lyman, who authored the CMA's 2011 policy called for decriminalization. "The California Medical Association believes the Adult Use of Marijuana Act is a comprehensive and thoughtfully constructed measure that will allow state officials to better protect public health by clarifying the role of physicians, controlling and regulating marijuana use by responsible adults and keeping it out of the hands of children," Dr. Steven Larson, CMA's president, said in prepared remarks.

Medical Marijuana

New Hampshire Patient Who Sued Over Medical Marijuana Access Dies. Linda Horan, who sued the state in November to issue her a medical marijuana card so she could get her medicine in Maine because New Hampshire dispensaries hadn't opened, died Monday at age 64. The ailing labor leader won her lawsuit and was able to procure medical marijuana out of state, but succumbed to cancer. The court ruling applied only to Horan, but days after the ruling, the states began sending out ID cards to patients.

Wyoming Medical Marijuana Initiative Won't Qualify for Ballot. A spokesman for Wyoming NORML, which organized the campaign, said Monday that the group had only managed to gather some 7,000 raw signatures ahead of next week's deadline and will fall far short of the more than 25,000 valid voter signatures required to make the ballot. The group will try again in 2018, it said.

Hemp

Twenty States Have Hemp Bills This Year, Vote Hemp Says. The industry group has issued its annual report and says 20 states are working to legalize or expand hemp production. There's much more in the report, too.

Drug Policy

White House Seeks $1 Billion to Fight Heroin and Prescription Opiate Abuse. The Obama administration Tuesday proposed a billion dollars in new funds over the next two years to combat widespread opioid use. More than $900 million of the newly sought funding would go for medication-assisted treatment (opioid maintenance), which also includes therapy. The administration said that 2.2 million people have been identified as needing treatment for opioid addiction, but only one million are receiving it.

Drug Testing

West Virginia Lawmaker Proposes Drug Testing Legislators. State lawmakers have once again introduced a bill to drug test welfare applicants, and in response, Delegate Shawn Fluharty (D-Wheeling) has introduced House Bill 2925, which would subject legislators to the same sort of testing. "There's no reason why state legislators should get a pass, simply because we wear suits," he said.

Drug War Issues

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